20130130 Permit Pkg 03012013 City of Yelm Permit No.: 20130130
Community Development Department Issue Date: 3/01/2013
� (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
MI�iN11M4TOM Fax: (360)458-3144
Applicant:
Name: LESTER RIECKEL Phone:
Address: 1512 YELM AVE W
YELM WA 98597
Property Information:
Site Address: 1512 YELM AVE W Owner: LESTER RFEICKEL
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: THREE BROTHERS CONST Phone:
Address:
222 YELM AVE
YELM WA 98597
Contractor License No.: THREEBC886Q9 Expires: 11/29/2014
Project Information:
Project: ROOF
Description of Work:
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
ROOF LESTER RIECKEL $ 25.00
TOTAL FEES: $ 25.00
Applicant's Affidavit: OFFICIAL USE ONLY
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yelm regulations including those governing zoning and land subdivision,and in addition,all covenants,
easements and restrictions of record. If applying as a contractor, I further certify that I am currently Final Inspection•
registered in the State of Washington. �
g , ���— Date �`��� � Date:
Si nature �
Firm By�
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: Parcel#:
Subdivision: Lot#: Plan#: Zoning:
' New Construction �3C Re-Model/Re-Roof/Addition � Home Occupation Sign
Plumbing Mechanical ' Mobile/Manufactured Home Placement �:' Other
Project Description/Scope of Work: j�)� t��� ����. ��°— �-C�,� � 'L����� �
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Project Value: � 3 ��0 7 �
Building Area(sq. ft) 15` Floor 2�d Floor Garage Deck
Basement Carport Patio
#Bedrooms_ # Bathrooms_ Heating: GAS/OTHER or ELECTRIC(Circle One)
Are there any environmentally sensitive areas located on the parcel?
/fyes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: �.�'E� ��.� ka—I
ADDRESS �1�. i h L � W G <F EMAIL
CITY e- ATE�_ZIP��-�9'7 TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR �1�ir ELEPHONE ��-. —7C��'
ADDRESS 2.� 1 rl f�-�L-• EMAIL S'c..v +n- r� S� �-o'�-'►
CITY -� STATE�13�ZIP 5' FAX
CONT CTOR'S LICENSE# C.,L�µR£�QG. EXP DATE_CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAI�
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
Copy of mitigation agreement with Yelm Community Schools, if applicable.
1 hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the
above described property will be in accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm.
� �
Applicant's Sig ature Dat
Owner/Contractor/Owner's Agent/Contractor's Agent(Please circle one.)
All permits are non-transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Auenue West (360)458-3835
Yelm,WA 98597 (360)458-3144 FAX
u�ww.ci.yelm.wa.us
Cit� of ��lm
(36 ) 458-84C12
REC#: U012CJ]52 3J01/1U13 1 .08 PM
�pER: CO 7ERM. 001
REF#; 1018
TRAN� 33,0000 �UILUIN(.a PkRMTTS
20130130 25.QOCR
f�IECKEL, I.ESTER
1512 YELM AVE W
RUOF 2.5.UOCR
TENUE�fED: 2�5,00 CHECK
APPLIED: 25,(10—
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CHANG�: 0.Uf)